If you’ve ever dealt with cramping, burning, or stabbing pain during or after sex, you know what a buzzkill it can be when wincing symptoms rob you of your bliss. There are many reasons why women have pain with sex and, well, the same goes for guys.
Men don’t report pain with sexual activity as frequently as women do, but they, too, have issues. An analysis in the Journal of Sexual Medicine found that 30% of women admitted to pain during vaginal intercourse, and 72% acknowledged pain with anal sex. Among men, only 7% and 15%, respectively, said they had pain with these sex acts. Researchers at Indiana University who conducted the study observed that “Large proportions of Americans do not tell their partner when sex hurts.”
Makes you wonder, do men open up about their pain in the privacy of the exam room?
“We see a ton of men with pain during sex; it’s a big problem,” Irwin Goldstein, MD, director of sexual medicine at Alvarado Hospital in San Diego, tells Health. He says the pain can hinder their ability to perform and may even dampen their interest in sex. “Listen, anything that distracts during the event of sexual intimacy is very disturbing,” according to Dr. Goldstein.
So if your male partner is stonewalling your flirty advances, maybe it’s him. He could have an infection, injury, or some other disorder that could explain why he’s just not into sex right now, and he’s not alone. Men from all walks of life, from the mega-athlete to the sedentary male, can have pain with sex for a whole slew of reasons, Jeanette Potts, MD, cofounder of Vista Urology and Pelvic Pain Partners in San Jose, tells Health. Fortunately, she points out, “the most common things are usually benign.”
Here’s why sex may be less than pleasurable for him:
He’s having painful erections
Peyronie’s disease, also known as curvature of the penis, is a common cause of penile pain—and can be an early sign of this condition. The exact cause isn’t clear, but researchers suspect it a may be set off by repeated trauma, or “micro-injuries,” to the penis due to something like rough sex or multiple attempts to have sexual intercourse with a weak erection.
Or it may be triggered by an acute event, such as a sports injury or even a mishap under the sheets. This can happen, say, when a woman is on top and the full thrust of her body weight comes down toward his penis in a way that misses her vagina but hits his erection. It can “fracture” his penis, Dr. Goldstein says. He’ll have pain and tenderness of the tunica albuginea, the membrane that helps sustain his erection.
Scar tissue, called plaque, develops under the skin of the penis, causing the signature bend or curve of Peyronie’s disease. And that can make vaginal and/or anal penetration challenging, as well as uncomfortable, for the man and his partner.
The type of treatment his doctor recommends—the options range from watchful waiting to surgery—will depend on the stage, symptoms, and severity of the condition.
RELATED: If Your Partner Has a Curved Penis, Here’s What You Need to Know About Peyronie’s Disease
The tip of his penis is inflamed
Swelling of the head of the penis, called balanitis, is often due to an infection, allergy, or some other skin irritation. It can affect any man, but it’s more common in those who are uncircumcised and men with uncontrolled diabetes. Although viral and bacterial infections are possible causes, balanitis is usually due to a fungal infection.
Think of it as the male version of a yeast infection. The foreskin can trap urine and humidity—and “fungus likes moist areas,” Abraham Morgentaler, MD, director of Men’s Health Boston in Chestnut Hill, Massachusetts, member of the board of the American Sexual Health Association, and author of The Truth About Men and Sex, tells Health.
A man may or may not notice some redness on the head of his penis, especially if it’s a mild case, he adds, “but it will be sensitive.”
Treatment for balanitis depends on the cause and severity. If yeast is the culprit, he’ll need a prescription for antifungal cream.
It hurts to ejaculate
Lot of things can cause pain with ejaculation. Often it’s a sign of prostatitis, or inflammation of the prostate, says the National Institute of Diabetes and Digestive and Kidney Disease.
The prostate gland is part of the male reproductive system; it secretes a fluid that helps make semen. Typically, when it becomes inflamed, a man will need to pee often, and he'll have burning with urination. It doesn’t usually cause pain with sex until the man ejaculates, and that can be uncomfortable, Dr. Morgentaler explains.
There are different types of prostatitis with different causes, so treatment will depend on results of a physical exam and medical testing.
Less commonly, if the man is having orgasmic pain (sometimes one-sided) and there aren’t other issues going on, you have to consider an ejaculatory duct obstruction, says Dr. Potts. However, this is a relatively rare condition; it’s diagnosed in 1-5% of infertile men.
His foreskin is too tight
Normally, the foreskin, which covers the head of the penis in an uncircumcised male, pulls back with erection. But when that fold of skin gets stuck or narrows at the tip and won’t retract, it’s called phimosis. And, according to Dr. Morgentaler, “that can be painful, definitely.”
Phimosis is more common in babies and young boys. In adult men, it’s often due to an underlying infection or inflammation (like balanitis) or an injury to the foreskin itself. Steroid cream and gentle stretching of the foreskin may be prescribed, or, particularly in recurring cases, circumcision.
A related condition, called paraphimosis, can occur after an erection when the retracted foreskin gets stuck behind the tip of the penis and can’t be pulled forward. It can cause permanent damage if left unresolved. Consider this a medical emergency.
He has blisters on his penis
A painful, blistering rash on his genitals? That’s the calling card of herpes, a common sexually transmitted infection (STI) that can affect women as well as men. Genital herpes is caused by one of two strains of the herpes simplex virus (HSV). HSV-2 is the main cause of genital herpes, but you can also get it from HSV-1, the same virus that makes your mouth break out in cold sores.
“Some guys will even get pain before the lesion presents,” Charles Welliver, MD, director of men’s health and assistant professor of surgery in the urology division at Albany Medical College in Albany, New York, tells Health. He says that can be a tipoff to a man that he's about to have a breakout. “It’s usually a burning-type sensation or burning pain,” he explains.
There’s no cure for herpes, but it can be successfully managed with antiviral medications to reduce the frequency and severity of symptoms.
RELATED: 6 Things Your Partner’s Penis Can Tell You About His Health
He has a short or tight frenulum
The frenulum (sometimes called the “banjo string”) is a band of skin on the underside of the penis that tethers the glans (the head of the penis) to the foreskin. (This length of tissue may be totally or partially removed in men who are circumcised.)
A short or tight frenulum, known as frenulum breve, can make it difficult for a man to retract his foreskin. When he has an erection, that taut piece of tissue can tilt the head of the penis downward, resulting in painful erections and pain with intercourse, says Dr. Welliver.
What’s more, Dr. Goldstein says it’s common for the frenulum to tear during sex. And that can cause pain and bleeding.
Treatment options range from no treatment (it may heal on its own) or frenuloplasty (frenulum-lengthening surgery) to circumcision.
He has a skin condition
Anything that irritates the penis, testicles, or groin can mess with a man’s sexual mojo. Up to two-thirds of people with psoriasis, for example, develop scaly patches on their genitals at some point in their lives, says the National Psoriasis Foundation. In men, the rash can show up on the glans, shaft, testicles, pubic area, buttocks, perineum (the area between the anus and scrotum), and all the adjacent skin folds.
Treating psoriasis on the genitals can be tricky because the skin in this area of the body is particularly sensitive. Men should discuss the options with their physician.
Less commonly, thin, white patches of skin may a sign of lichen sclerosus. Guys with this condition can get tearing of the skin of the penis during intercourse or with an erection, says Dr. Welliver.
His condom is to blame
Allergic contact dermatitis is an itchy, inflamed skin rash that can occur when skin is exposed to an allergen that triggers a reaction. BMJ Case Reports describes one such episode involving a 30-year-old male who developed skin lesions on his penis after wearing a premature ejaculation condom containing 5% benzocaine, an anesthetic intended to prolong his sexual experience.
Although latex is notorious for triggering allergic reactions, the man had a history of using latex condoms without any problems, and patch testing confirmed that he was allergic to benzocaine.
It’s really a nerve issue
Is your man into cycling or martial arts? What he perceives as penile pain may not be a problem with the organ itself. Sitting on a bike seat or getting kicked in the groin can hurt the pudendal nerve, which supplies sensation to the genital area. Painful intercourse is one of many possible symptoms of pudendal neuralgia.
“The nerve gets irritated and it refers back to the penis,” Dr. Goldstein explains.
Even something like a low-back problem due to an annular tear or age-related wear and tear of the discs in the spine can manifest as penile pain, he adds, which means doctors really have to do some detective work to figure out where the pain is coming from.
He’s tense or anxious
When marital, extramarital, or relationship issues are weighing on his mind, a little bit of physical discomfort can get blown way out of proportion. Pain in the genital area “gets pretty revved up,” Dr. Potts observes.
“It doesn’t mean that the pain is fictitious,” she explains. “It just means that that area of the body is very susceptible to stress.” And that, she adds, can magnify symptoms.
Pain with no discernible medical cause can also affect men who have been raped or sexually abused, says Dr. Goldstein. “It’s generated by the PTSD experience—the fear, the anxiety,” he explains. The pain they experience is very real—it’s registered in the brain, which he describes as our “largest sexual organ.”
He’s just having a lot of sex
If a man is getting more action than usual (such as in a new relationship) or finagling some funky new positions to keep things interesting, he may find that his penis aches after sex. More often than not, it’s nothing to worry about.
“People don’t realize how much the penis gets bent during intercourse one way or another,” says Dr. Morgentaler. “If it happens for only a few hours after sexual activity, I tell them it’s completely normal." It usually goes away in a day or two, he adds.
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